On a recent flight across the country, the person next to me
commented on an article in the seat-pocket magazine on
"Molding Morality" by Michael K. Myerhoff [1]. This
article was written around the following case. A pay phone in a
college dormitory returns money that students put into it, but
the connections go through anyway. All the students take
advantage of it, but the father of one of the students says it is
"not right," and that student ultimately reports the
trouble to the telephone company. Mr. Myerhoff applauds the
father's discretion for judging the action without judging the
student. That seems like a good point, but it falls short of
equipping the student to resolve future moral questions without
help.

According to Mr. Myerhoff, the moral judgements of children
are fairly predictable from their social and religious
backgrounds. He goes on to say that the moral judgements of
adults are less predictable because many diverse skills are
needed to make sound moral judgments. But he says that sound
moral judgements are distinguishable from unsound ones by
examining the reasoning behind them. Thus Mr. Myerhoff seems to
believe that moral judgements are characteristically ones on
which responsible adults can convincingly disagree. I prefer to
take a more constructive approach by defining what I will call
objective morality. If someone wants to disagree, let them
produce counter examples that are clearly moral issues but do not
fit the definition.

Working Definition

Some philosophers have argued that morality is based on
reason, and others have found an emotional basis for it. If
morality is based on reason, we may hope to learn its principles
and thereafter apply it confidently without help. If morality is
based on emotion, it must be a weak effect because moral issues
often manifest themselves as conflicts between reason and other,
stronger emotions that we recognize to be amoral. Now, if we
can't trust our own emotions, we will have to find a rational
basis for morality anyway. My suggestion is that, to a first
approximation, an action should be considered moral or immoral to
the extent that it tends to lengthen or shorten another person's
life. On this scale , the merit of resisting the temptation to
take advantage of a defective payphone is insignificant.

It is especially immoral to endanger another person for
momentary pleasure, yet people still find excuses for it. For a
while, it looked as though antibiotic drugs had eliminated the
accountability that goes with having intimate contact with more
than one other person. Unfortunately, the sexual revolution
failed, and the tyranny of sexually transmitted diseases goes on.
A person who engages in behavior that potentially spreads such
diseases risks only his or her own life on the first occasion.
After that, a responsible person should have a check-up before
having another affair. Otherwise, that third person's life is
potentially at risk as well. The sin is knowing that you could be
infected and doing it anyway.

A Possible Counter Example

I admit that my definition of objective morality might not
always work. For example, suppose that a person has a terminal
disease and is in great pain. Actually, pain management can give
a terminally ill person an opportunity to reach closure with the
people they are close to. This kind of relatively happy ending is
probably medically possible in most cases, but it is probably
often psychologically unfeasible. A savvy patient who is bitter
and weary of life may lie about the pain with suicidal intent.
Although physicians are not likely to be fooled in such cases, it
may be kinder for them to play along in mutual deception. Thus it
seems possible to me that shortening a life is not necessarily
immoral if it prevents great suffering, even if the suffering is
partly psychological.

We might say, against the working definition, that an action
that shortens somebody's life might be morally justified if it
eliminates unnecessary suffering. The problem is, who can decide
whether suffering is necessary or not, keeping in mind that the
physical pain can probably be managed? Just now Jack Kevorkian is
pushing the limit of the law on this point [2], and he has even
gotten himself convicted of murder. My intuition is that a
qualified impartial judge should be called on to decide whether
suffering is necessary or not in each case. Certainly, a family
member or another person who is emotionally or financially
involved cannot be objective, and even physicians have
traditionally refused this burden. This is very clearly stated in
the Hippocratic Oath [3] in the line "I will give no deadly
medicine to any one if asked, nor suggest any such counsel
..." I think the point was probably to reassure patients
that the advice and medicine they receive will always be for
their own good.

Incidentally the sentence quoted from the Hippocratic oath
continues "and in like manner I will not give a woman a
pessary to produce abortion." I have been told that students
at some medical schools now take an updated oath that does not
preclude abortion, and I want to characterize this as a
hypocritical oath instead of a neo-Hippocratic oath. If
circumstances arise where abortion is necessary to eliminate
unnecessary suffering, so be it. But it would be hard to argue
that a human life is not shortened thereby, so I think a
qualified impartial judge should be consulted in every case. I
hasten to add, as Mr. Myerhoff's father's silence implied, that
women who have had abortions are "not wrong" and even
doctors who have performed thousands of abortions have good
intentions and can be redeemed.

A Case in Point -- Needle Sticks

According to OSHA [4], at least 800,000 accidental needle
sticks occur each year. The gravity of these incidents was
assayed by a study done in the Johns Hopkins Hospital emergency
room. Of 2500 patients tested there, 18% were seropositive for
hepatitis C, 5% were seropositive for hepatitis B, and 6% were
seropositive for aids. The probability of being infected with
aids from a contaminated needle is currently estimated to be 0.3
%. This means that about 144 infections probably result each year
from 48,000 exposures to aids through accidental needle sticks.
(This number is about 3 times the number of documented cases.)
Hepatitis B and C are much more transmissible through needle
sticks, but fortunately vaccination has been reducing the
incidence of acute cases of hepatitis B since the mid-80s.
However, health-care workers are about twice as likely to die
from this disease as the average for the general population.
There is no vaccine or cure for hepatitis C, which is a major
cause of chronic liver disease. It has been estimated that more
than 500 health-care workers contracted this disease through
occupational exposure in 1995.

Currently, health care workers are admonished to take
"universal precautions" under which the blood and
certain body fluids of every patient are deemed potentially
hazardous. Health-care workers are hardly reassured by this pious
BS. Gloves and face shields are used routinely, but they are
ineffective against needle sticks. From the time a needle is
withdrawn from a patient, until it is inside a puncture-proof
disposal container, a used needle is rather like a loaded gun. It
can be handled safely if given one's undivided attention, but
often there is a lot going on in treatment rooms. My suggestion
to health-care workers is that they should yell "...NEEDLE..."
loudly as they withdraw one from a patient, and everybody else
who is present should freeze and be mindful of the needle until
it has been safely disposed of.

The problem of handling contaminated needles became a moral
issue in medicine when a retractable syringe became available
[5]. This needle disappears into the body of the syringe
immediately after delivering its contents. The unit cost for this
retractable syringe is currently about 50 cents. The unit cost of
conventional needles is much lower, and a 1000-bed hospital may
use about 500,000 needles per year. Hospital administrators are
therefore probably hung up on the incremental annual cost of
about $250,000. Health-care workers, on the other hand, should
and probably do know that they save their employer less than 50
cents each time they risk exposure to a contaminated needle. If
hospitals were required to use retractable needles, the unit cost
could come down very rapidly and the difference might eventually
become negligible. This is because of the well-known learning
curve effect [6], which says that the unit cost of almost
anything decreases by about 25% for each doubling of its
cumulative production.

Who should decide whether health-care workers should risk
exposure to contaminated needles at an incremental benefit to
their employers of less than 50 cents per exposure? It is a moral
issue because health-care workers' lives are being shortened by
the decision that most hospital administrators have made to date.
The moral aspect of the issue is probably magnified because
anecdotal evidence suggests that talented individuals are leaving
active health-care delivery to pursue other, safer opportunities.
If this is true, the remaining pool of health-care workers
contains relatively untalented and apathetic individuals. Is this
the kind of health-care worker you want to encounter when your
health is at stake?